Frequently Asked Questions

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Therapy IS expensive! I thought it may be helpful to give you an idea what goes into my fee at a one-person, online, private practice. 

1. Getting started: Before my graduate program, I had to complete an undergraduate degree with student loans. My graduate program was four years, funded by more student loans, about $50 000. The graduate program included 700 hours or ten months of unpaid work at a community mental health agency. I then had to pay for a professional exam, and begin the path to licensure as an intern. I worked at the lowest pay rate in the industry in order to obtain my requisite 3000 supervised hours. Due to COVID and relocations, my internship took almost four years. During my intern time in Texas, I had to pay for weekly supervision as if in therapy myself. Supervised hours mean earning less money than fully licensed clinicians. 

2. Costs of a private practice: working from home reduces many overhead expenses, but it requires an initial capital layout. Professional equipment and furniture are required. Ongoing expenses include monthly utilities, pro rata mortgage costs, subscription to an electronic patient portal and virtual delivery service, google business service for HIPAA protected email, online banking, website subscription, therapy database marketing as well as tax accounting services. Any clinician must also carry the costs of applying for and maintaining licensure, obtaining records, maintaining professional indemnity insurance and ensuring annual continuing education credits in training.

3. Training: I do an inordinate amount of training. That is what makes me better at my job. High-end training is expensive because it compensates expert trainers for decades of clinical experience. EMDR, DBT, IFS, Ego State and Clinical Hypnosis trainings are all multi-stage trainings with individual or group consultation hours after the actual training. I belong to multiple consultation teams where I meet face-to-face with an expert for an hour each week or month. (I also buy more books on therapy than I have place to store.) These trainings and consultations keep me ethically and legally accountable for your safety. Although my training is a high-cost item in my practice, it directly translates to the value for your money. 

4. Invisible labor: I spend much more time maintaining my practice than I can charge money for. A lot of personal time is devoted to managing my client schedule between sessions and after hours, responding to inquiries and texts seven days a week. I maintain assessment and progress notes for each client, and have to document all communications between sessions. Clients sometimes require additional administrative help with online billing or insurance. I spend a significant amount of time marketing my practice. I offer consultation on my specialty to other therapists for free. I maintain my website with updated information about my practice. I speak to parents and spouses for free on the phone. Other things I don't charge for is: preparing before each session, showing up well in advance, and making sure I am appropriately dressed and organized for your time with me. Finally, in our I am 100% absorbed in the details of your life. My fee has to compensate me for recovering afterwards to prevent burnout.

5. Market norms: My fees are not out of proportion to what clinicians in the local market charge. In big cities, therapy easily costs $200-$350 per session, whereas fees in remote areas are closer to $100-$200. Although this still seems expensive, it is ultimately in your interest that my fees do not drastically undercut the fees of other therapists. We will simply stop providing mental health services when we can no longer make a living. If some of us ask too low fees, it pushes others out of the market. Those who ask a very low fee may have a second income through a partner, or little clinical experience. I try to compensate for high market rates by offering a special fee accommodation to 10% of my caseload. For instance, if I have about 25 clients on my case load, I can offer at least two clients the therapy fee that they can afford. Yes, you read that right. If you earn minimum wage, I only charge you what you earn in one hour of work. Unfortunately these spots do not become available very often. If you want to get on my waiting list for this fee accommodation, please send me an email. I would love to keep your name until I can make the same offer to you.

6. Background: I entered this profession as my third career, and bring prior professional skills to my current work. This distinguishes me from someone who has only studied and worked in this field. I studied law for six years in South Africa, I practiced law as a public defender and I completed an additional Master's degree in International Economic Law. I learned to research and litigate in front of appellate division judges. I also taught college-level English in Korea for many years, and studied for five years to obtain my PhD in English Literature. I am capable of academic publications and critical thinking. I am a more mature counselor because of this background. I also have a personal journey in my own mental health that contributes to my genuineness in therapy. Your fee gets you a well-rounded counselor.

You always have the right to cancel therapy or reschedule a session without giving me an explanation. However, I require 24-hours notice if you need to change your appointment. I get that it is not always possible to give 24-hours notice. It will feel very unfair when I take your money when you had an emergency or couldn't foresee cancellation. The cancellation policy is not intended to punish you. It is intended to compensate me for having a private practice. I run my business in good faith that you will attend, and I offer you a slot on my schedule before you pay. You can trust me to protect your reservation. If you do not show up, I still have to carry the operating costs of this business model. Although you only rarely need to cancel, I get cancellations every day! I regret not granting you the favor of simply missing a session, but I won't be able to keep my business profitable if I help everyone.

Let's be honest, talk therapy is only one pathway to wellness. There are many alternative routes. If I think you will benefit more from something outside my scope of practice, I am going to let you know. Here's how I believe talk therapy can help: it helps you overcome the avoidance of internal experience, it helps you articulate  your experience, it helps you absorb new learning  and it helps you create a narrative of meaning for your life. It is also a profoundly trusting relationship where you can heal through my attention and attunement. In this relationship you can heal from attachment wounds and relearn interpersonal effectiveness.  I also subscribe to non-talk therapy when indicated.

Clients typically worry that telehealth will not feel as intimate as in-person therapy. I get why that seems true, but it is not actually born out by most people's experience. What everyone truly wants through therapy, is a genuine connection. Good therapy is going to depend on how real, how compassionate and how skilled your therapist is in their work. None of this depends on technology. My clients feel my genuineness, transparency and my empathy. They don't feel hindered by a virtual connection because they fully experience the human connection. Online therapy is so much safer and cheaper than in-person therapy. It makes a tremendous difference when you work long hours, you don't have childcare or leaving the house horrifies you. It also means you can get treatment regardless of how far away you live. Telehealth is appropriate if you have a stable Internet connection, and you can focus your attention for the duration of one session.

Unless you do psychoanalysis, therapy ends. There, I said it! This means you should always be mentally prepared for therapy to end. Therapy simply ends when it is no longer therapeutic: either you have completed your goals, or we can no longer work on your goals (more on fit here below). If therapy has no goal, talking becomes a goal in itself. This quickly leads to a friendship of sorts, dependency and harmful messages around healthy boundaries. After you have reached your therapy goals, I welcome once a month check-ins so that you can continue to feel supported.

All therapists should start out determining "fit", that is, whether they are in a position to treat you. Therapists are ethically obliged to do no harm, and make the client's welfare of paramount importance. It is no small thing to enter into a relationship of trust with a vulnerable individual when there is such a big power differential. You should insist that your therapist know their stuff and has previous experience, education and supervision in the issues you bring to therapy. It can be very alarming when your therapist wants to "refer you out." You may feel that you are not enough, or too much, or too sick to help. I understand why you may feel that way, but I want to reassure you, a referral is always a good thing. It means you are getting away from someone who cannot or does not want to treat this issue. It is alright for therapists to have such limits, and it is alright for you to find someone who can and wants to work with your issues. 

Texas: https://www.bhec.texas.gov/verify-a-license/index.html

Arizona: https://azbbhe.portalus.thentiacloud.net/webs/portal/register/#/

Idaho: https://edopl.idaho.gov/OnlineServices/_/#11

Florida: https://flhealthsource.gov/telehealth/

South Carolina: https://llr.sc.gov/TeleHealth/Counselor.html

I accept all the insurance partners of Alma (www.helloalma.com)

The following commercial insurance companies participate (are in-network) with Alma’s insurance program:

• UnitedHealthcare
• UnitedHealthcare Shared Services (UHSS)
• GEHA - UnitedHealthcare Shared Services (UHSS)
• Oscar
• Oxford
• UHC Student Resources
• UMR
• All Savers (UHC)
• Health Plans Inc
• Medica (Eligible if policy is commercial only)
• Surest (Formerly Bind)

Optum is inclusive of several health plans that Alma does not currently accept, including:

• Select Health
• Health Plans of Nevada
• Cenpatico
• Sierra Health and Life Health Plans
• Arizona Complete Health
• Optum Medicare and Medicaid plans

• Meritain
• Nippon
• Allied Benefit Systems
• GEHA - United Healthcare Shared Services (UHSS)
• Trustmark
• Trustmark Small Business Benefits
• Health Scope
• Christian Brothers Services

Aetna is inclusive of several health plans that Alma does not currently accept, including:

• GEHA - Aetna**
• Boon Chapman
• AmeriBen
• Health First
• Piedmont/S&S Healthcare
• Health Smart
• Emi Health
• WebTPA
• Aetna Medicare and Medicaid plans

Perhaps you are new to therapy and feel really nervous about what you should say. I am going to put you at ease! Please take a chance and tell me what concerns you.

Or perhaps you are no stranger to therapy, but had mixed results in the past. You are willing to give it another try, but unsure if the same bad thing is going to happen. Please ask me directly about the way I work. Let's talk about what didn't work for you in the past. I am here to answer your questions.

Email me at info@marikajoubert.com or text 480-482-0156